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Peds Week 5 > Neuro > Flashcards

Neuro Flashcards

1
Q

What are the main differences between adult and pediatric brains?

A

Brain not fully developed

Nerve cells immature

Incomplete myelination at birth

Brain cells easily damaged if blood flow and oxygenation not maintained.

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2
Q

What reflexes should be gone for good once they go away?

A

Moro and Babinski

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3
Q

What are early signs of increased intracrainial pressure?

A

headache

vision trouble

nausea/vomiting

subtle changes in vital signs

pupillary slowing

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4
Q

What are ICP signs for babies?

A

Vague

Look for:
Irritability
Cat-like crying
Bulging fontanel
Bradycardia (below 160)
Cushing's triad
Sluggish pupil reaction
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5
Q

What is cushing’s triad?

A

irregular respirations
widening systolic
bradycardia

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6
Q

What is confusion?

A

impaired decision making

disoriented to person, place, time

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7
Q

What is delirium?

A

State of confusion, fear, irritiability, or agitation

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8
Q

What is lethargy?

A

sleepy, rousable with moderate effort, sluggish speech

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9
Q

What is stupor?

A

Deep sleep, responds only to vigorous and repeated stimulation

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10
Q

What is coma?

A

No motor or verbal response to noxious stimuli

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11
Q

What is a permanent vegetative state?

A

permanent lost function of cerebral cortex

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12
Q

What is the best score for GCS?

A

15

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13
Q

What is the worst score for GCS?

A

3

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14
Q

If patient on mannitol, what labs should be monitored?

A 
Kidney
Livery
Heart
BMP
CBC
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15
Q

What IV solution given to child with increased ICP?

A

hypertonic saline

may be more effective than mannitol for reducing ICP

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16
Q

What labs should be monitored for child with ICP?

A

electrolytes

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17
Q

Is it ok to suction patient with ICP?

A

No!!

Very contraindicated

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18
Q

How should ICP patient be positioned?

A

HOB 30 degrees

Avoid neck vein compression

Head placed midline

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19
Q

How should environment sound for child with ICP?

A

minimal or no environmental noise

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20
Q

Avoid stressful activities such as ___ and ___ that may increase ICP

A

eliciting pain

emotional stress

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21
Q

What meds will be given to ICP patient who is on a vent?

A

sedatives
analgesics
paralytics

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22
Q

What is epidural hematoma?

A

bleeding between dura and skull

hematoma formed

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23
Q

What is subdural hematoma?

A

Forms more slowly

Birth trauma, falls, shaken baby syndrome

swelling in small space makes high risk for ICP

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24
Q

What is cerebral edema?

A

24-72 hours after head trauma.

If child loses consciousness or vomits more than 3 times, see doctor!

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25
Q

What are the priorities for seizure patient?

A

Airway
Protect from injury
Medication safety

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26
Q

How is airway protected in seizure patient?

A

position on side

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27
Q

How is seizure patient protected from injury?

A

pad rails

helmet

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28
Q

What is medication safety for seizure patient?

A

SLOW IV PUSH

If going for surgery, give meds with one sip of water even if NPO

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29
Q

What is ketogenic diet?

A

high fat

low carb

30
Q

What equipment should you need nearby if child is seizure?

A

oxygen

suction

31
Q

What medications are given for seizures?

A

Benzo

Phenobarbitol

phenytoin (Dilantin
fosphenytoin (Cerebryx)

carbamazepine (Tegretol)

valproic acid (Depakote)

32
Q

Is it ok to abruptly discontinue seizure medications?

A

No. Must taper down

33
Q

What is status epilepticcus?

A

continuous seizures for up to 30 minutes

34
Q

What medications are given for status epilepticcus?

A

rectal diazepam (Valium)

intranasal midazolam (Versed)

IV diazepam or lorazepam (Ativan)

35
Q

What do we teach home management of seizures?

A

CPR for family members

Rectal diazepam for intractable seizures

No swimming alone

36
Q

What are s/sx of Reye Syndrome?

A

cerebral edema

elevated liver enzymes and ammonia

37
Q

What is cause of Reye Syndrome?

A

viral infection treated with aspirin

38
Q

What meds are given if child has viral illness or fever?

A

acetaminophen or ibuprofen

39
Q

What is hydrocephalus?

A

imbalance in production and absorption of CPF

40
Q

What is hydrocephalus associated with?

A

myelomeningocele

41
Q

What are s/sx of hydrocephalus?

A 
Abnormal head growth
Bulging fontanel
Dilated scalp veins
Separated cranial sutures
Frontal enlargement
SETTING SUN EYES
Depressed eyes
Irritability
Lethargy
high-pitched cry
42
Q

How is hydrocephalus relieved?

A

Drainage of CSF from ventricles via shunt

43
Q

When is the period of greatest risk for VP shunt placement?

A

first few months

44
Q

What infections can arise from shunt infection?

A

meningitis
ventriculitis

septicemia
bacterial endocarditis
wound infection
shunt nephritis

45
Q

How is shunt infection treated?

A

massive dose of IV abx or shunt removal

46
Q

What is spina bifida cystica?

A

VISIBLE DEFECT with external saclike protrusion

47
Q

What is a meningocele?

A

Sac contains meninges and spinal fluid but NO NEURAL ELEMENTS.

NO neurologic deficits

48
Q

What is a myelomeningocele?

A

Sac contains meninges, spinal fluid and nerves

49
Q

Where is myelomeningocele/myelodysplasia normally seen?

A

Anywhere along spinal column, but common in lumbar and lumbosacral areas.

50
Q

What does the sac contain in myelomeningocele?

A

meninges
spinal fluid
nerves

51
Q

Myelomeningocele is a term often used interchangeably with ___

A

spina bifida

52
Q

If myelomeningocele located below 2nd lunar vertebra, what are the symptoms?

A

flaccid paralysis of lower extremities

sensory defecit

53
Q

Is there uniformity on both sides of defect with myelomeningocele?

A

not

54
Q

Myelomeningocele sac may be prone to leakage of ___ if ruptured?

A

CSF

55
Q

What is the number one thing to prevent with myelomeningocele?

A

infection

56
Q

When is surgical closure done of myelomeningocele?

A

within first 24-72 hours

57
Q

What position do we place child with myelomeningocele?

A

prone

58
Q

What neuro assessment is performed on child with myelomeningocele?

A

assess extremity movement and infant behavior.

59
Q

Do we take rectal temperatures on baby with myelomeningocele?

A

no

60
Q

What physical assessments are done on baby with myelomeningocele?

A

observe urine output
observe for abdominal distention
measure head distention
assess fontanel for bulging

61
Q

How are myelomeningocele children bedded?

A

in isolette

no clothing

62
Q

How is myelomeningocele dressed?

A

moist, sterile dressing

sterile water
sterile dressing
sterile gloves

sterile, sterile, sterile!!

63
Q

What is cerebral palsy?

A

abnormal muscle tone, disorder of development of movement and posture.

64
Q

Is cerebral palsy progressive?

A

No. The damage you see is the damage they have

65
Q

What is the most common cerebral palsy?

A

Spastic

66
Q

What is spastic cerebral palsy?

A

hypertonic
poor control of posture, balance, and coordinated motion
poor fine and gross motor skills

67
Q

What are physical s/sx of spastic cerebral palsy?

A

Poor head control after 3 mo

stiff or rigid limbs

arching back, pushing away

floppy tone

unable to sit without support at 8 months

clenched fists after 3 months

68
Q

What are behavioral s/sx of spastic cerebral palsy?

A

Excessive irritability

no smiling by 3 months

persistent tongue thrusting

frequent gagging or choking with feeds

69
Q

What are goals of therapy for CP patients?

A

Helping them maintain function and be as normal as possible:

establish locomotion, communication, and self-help skills

gain optimal appearance and integration of motor functions

correct associated defects as effectively as possible

provide educational opportunities adapted to child’s capabilities

promote socialization experiences

achieve max independence

70
Q

What are some therapeutic management for CP?

A

Ankle/foot braces

orthopedic surgery to correct spastic deformities

PT/OT

71
Q

What is neuroblastoma ?

A

malignant extracranial tumor

72
Q

Where can neuroblastoma develop?

A

Anywhere along SNS chain:

abdomen
adrenal
thoracic
cervical

Peds Week 5 (3 decks)

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